[Effect of 2% ganciclovir eye drops on cytomegalovirus positive Posner-Schlossman syndrome]

Abstract

Objective: To observe the effect of 2% ganciclovir eye drops on Posner-Schlossman syndrome (PSS) patients with positive cytomegalovirus (CMV) in aqueous humor. Methods: Prospective study. The cases clinically diagnosed as PSS with positive CMV were enrolled from August 2017 to January 2018 at Department of Ophthalmology, Eye & ENT Hospital of Fudan University. All patients underwent aqueous and serum analysis for CMV by the enzyme linked immunosorbent assay and polymerase chain reaction. The history and clinical signs were noted, 2% ganciclovir eye drops were prescribed for topical use (4 times per day), and the patients were followed up. The Pearson Chi-square test was used for the comparison of factors including keratic precipitates (KPs), and the Tyndall, and paired t test or Wilcoxon rank sum test was used for factors like intraocular pressure (IOP), corticoid dosage, and IOP lowering medication dosage. Results: Fifty cases (31 males and 19 females) clinically diagnosed as PSS with positive CMV had an average age of (38±13) years. Some characteristics could help to identify CMV-positive PSS: iris depigmentation (96%, 48/50), coin-shaped KPs, loss of corneal endothelium (an average loss rate of 10.8%±5.5%), and high IOP during attack[(47.8±9.9)mmHg,1 mmHg=0.133 kPa]. After topical antivirus therapy with the mean time of (5.4±2.7) weeks, the clinical manifestations of CMV positive PSS cases improved. The granulomatous or middle-sized KPs decreased from 94%(47/50) to 52%(26/50), the coin-shaped KPs almost disappeared [from 22%(11/50) to 2%(1/50)], and the Tyndall reaction disappeared [from 12%(6/50) to 0]. The mean IOP value decreased from (26.2±10.9) mmHg to (15.5±3.6) mmHg. Furthermore, corticoid use decreased (from 3 times per day to 0 time per day, by median value), the number of cases that did not use corticoids increased from 6% (3 cases) to 60% (30 cases), and 17 (65%) out of those 26 corticoid dependent patients could withdraw corticoids. The number of IOP lowering eye drops used also decreased (from 2 to 0, by median value), and the proportion of cases without IOP lowering medication increased from 24% (12 cases) to 58% (29 cases). There were statistical differences between post-treatment and pre-treameat (all P<0.05).Thirteen cases that accepted CMV re-test of aqueous humor were all CMV DNA negative after treatment. Conclusion: Topical treatment with 2% ganciclovir eye drops has a good short-term effect on CMV-positive PSS patients by contributing to inflammation and IOP control. (Chin J Ophthalmol, 2018, 54: 833-838).

Keywords: Cytomegalovirus; Ganciclovir; Glaucoma; Ophthalmic solutions; Uveitis, anterior.